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Life Expectancy in HIV
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Here are 2 HIV Life Expectancy studies getting attention on the internet, here is a full inclusive review of what these studies report and below is a link for comparison to life expectancy in HIV-negs. Take a look at the discussion below about inflammation. Note the NA-ACCORD study estimates future life expectancy, the study in AIDS journal, review the full text(pdf) through link below, take a look at the ages of the study participants and the discussion on inflammation.
IAS/2013: Life Expectancy With HIV Jumps 15 Years From 2000-2002 to 2006-2007 in US, Canada -
The NA-ACCORD team concluded that "a 20-year-old HIV-positive individual on ART in the US or Canada is expected to live into their early 70s, a life expectancy approaching that in the general population." But HIV-positive women, nonwhites, injection drug users, and people starting ART with fewer than 350 CD4s still trail HIV-positive comparison groups and the general population in life expectancy........Overall life expectancy at age 20 rose from 36.1 in 2000-2002 to 45.2 in 2003-2005, and to 51.4 in 2006-2007. The 2006-2007 estimate means a 20-year-old starting antiretroviral therapy in those years could expect to live to age 71.4. Women and men had comparable life expectancy in the first two study periods (2000-2002 and 2003-2005), but men had a 6.1-year longer life expectancy in 2006-2007 (53.4 versus 47.3).......Among men infected during sex with men, life expectancy at age 20 climbed from 53.3 in 2000-2002 to 57.4 in 2003-2005 and to 69.3 in 2006-20007. So a 20-year-old man starting treatment in 2006-2007 could expect to live to 89.3. In contrast, life expectancy among injection drug users was much lower and did not improve over those three periods: 29.5, 31.0, and 28.8. Among people infected by another route, life expectancy jumped from 43.5 in 2000-2002, to 52.4 in 2003-2005, and to 56.1 in 2006-2007.......Life expectancy at age 20 among whites remained fairly stable over the three study periods, inching up from 52.7 in 2000-2002, to 53.6 in 2003-2005, and to 56.9 in 2006-2007. In those same three periods, life expectancy among nonwhites rose rapidly but still far lagged life expectancy among whites in the third period: 29.7 in 2000-2002, to 40.7 in 2003-2005, and 48.4 in 2006-2007.
List of countries by life expectancy (gen pop).....http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population, AIDS March 27 2013
http://www.natap.org/2013/HIV/062313_01.htm
Mortality in well controlled HIV in the continuous antiretroviral ...www.natap.org/2013/HIV/062313_01.htm...
Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population
"In our study, individuals who had current or recent CD4 T-cell counts above 500 cells/ml had no evidence of increased overall mortality compared with the general population. In contrast, those who had CD4 T-cell counts between 350 and 499 cells/ml had evidence of higher mortality rates.......For individuals with a CD4 T-cell count between 350 and 499 cells/ml, 28 deaths were observed (against 16 expected) in 3729 years of follow up, indicating that mortality rate was increased compared with the background population (SMR 1.77, 95% CI 1.17-2.55). However, for individuals with CD4 T-cell counts above 500 cells/ml, no evidence for increased mortality was seen with an SMR of 1.00 (95% CI 0.69-1.40)......The median age at randomization was 43 years [interquartile range (IQR).....The median length of follow-up was 3.1 year
37-50 years]inflammation.......data collectively suggest that mechanistic pathways not captured by viral load and CD4 T-cell count data might contribute to higher than expected morbidity and mortality in treated individuals.......Our data support the importance of early diagnosis and treatment to improve clinical outcomes......The commonest cause of death was cardiovascular disease (CVD) or sudden death (19, 31%), followed by non-AIDS malignancy (12, 19%), unnatural deaths (accident, suicide or violent death) in 11 cases (18%), non-AIDS and nonhepatitis infection (six, 10%) and liver disease (five,8%).Onlytwodeaths(3%)wereAIDS-related"
'The role of chronic inflammation in driving disease in treated adults has been a strong focus of investigators working with the SMART and ESPIRIT cohorts. These studies have consistently found that markers of inflammation [e.g. interleukin (IL)-6 and sCD14] and coagulation (D-dimers) are elevated among treated individuals (as compared with well matched uninfected adults) and strongly associated with subsequent morbidity and mortality [26]. Moreover, there have been limited associations between the proximal CD4 T cells and inflammation/coagulation markers in these studies. These data collectively suggest that mechanistic pathways not captured by viral load and CD4 T-cell count data might contribute to higher than expected morbidity and mortality in treated individuals. On the basis of these observations, it might be expected that inflammation might remain elevated among individuals who have maintained viral suppression and high CD4 T-cell counts (500 cells/ml) and that this might predict excess disease. Of note, emerging data from the study of human ageing suggest that the cumulative harm associated with persistently low-level inflammation may only become apparent as people enter their sixth and later decades of life [27]. It remains a distinct possibility that excess morbidity and mortality among optimally treated adults may hence only become apparent as the current generation of treated HIV-infected individuals age"
"Our data support the importance of early diagnosis and treatment to improve clinical outcomes, and it is likely that much of the excess mortality associated with HIV would be preventable with timely diagnosis of HIV and initiation of ART [21]. In individuals who start ART at a CD4 T-cell count less than 200 cells/m full reconstitution and normalization of CD4 T-cell count above 500 cells/m is unlikely to be achieved even after several years of ART therapy [20,22]. In addition, optimizing individual patient responses to ART is vital through addressing factors that affect adherence and developing effective interventions to improve adherence and therefore long-term outcomes"
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